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Staff strategy needed to improve work conditions in long-term care, employee reps say

Experts with the non-profit Health Standards Organization released updated guidelines this week for delivering high-quality long-term care, stressing the need to attract and keep enough workers in homes to properly look after residents.
A resident is shown in a room at a seniors residence in Laval, Que., Saturday, September 26, 2020. Proposed new standards for long-term care issued by a panel of experts at the Health Standards Organization on Tuesday say residents should get at least four hours of direct care a day and workers must be paid more.

Governments must go beyond new national standards to make working in long-term care a profession of choice if they hope to address serious staffing issues that led to deadly conditions for seniors during the COVID-19 pandemic, representatives of the workers said Wednesday.

Experts with the non-profit Health Standards Organization released updated guidelines this week for delivering high-quality long-term care, stressing the need to attract and keep enough workers in homes to properly look after residents.

The standards, which are not currently enforced, recommend a pay raise and opportunities for full-time employment.

"The biggest challenge for many long-term care homes right now is retaining and recruiting staff, especially when hospitals are facing significant staffing shortages and pay much higher," said Dr. Samir Sinha, chair of the committee that developed the new standards.

But giving more money to support workers, who provide the majority of bedside care, isn't the whole solution, said Miranda Ferrier, president of the Canadian Support Workers Association.

"It's not an easy job," she said. "You're dealing with literally everything about a human being, fluids and all, and some people can't handle that."

University of Alberta Prof. Carole Estabrooks, who sat on the committee, said meeting the standards is only a starting point and won't immediately address the dire and urgent need for more workers.

"Until there's a co-ordinated, national-provincial health workforce strategy that includes long-term care, it's going to be difficult to dig ourselves out of this really profound global emergency we're in, with respect of the workforce," Estabrooks said.

"It's hard to do because the needs are so urgent."

Even before COVID-19 began to spread through Canada's long-term care homes in 2020, most homes were understaffed.

Ferrier began working in long-term care in 2006 and never worked a fully staffed shift. There simply weren't enough staff to maintain a basic level of care and dignity for residents, she said.

"I remember feeling devastated," she said. "When you try to spend as much time as you can with your residents, talk to your residents, engage with them — but you don't have time."

Once the pandemic arrived, those staff shortages had deadly consequences, as the vast majority of Canadians who died of COVID-19 in early 2020 were long-term care residents.

Now the workers are burnt out and many have left, Ferrier said.

Personal support workers, or PSWs, are largely unregulated in Canada, though some provinces have moved to change that. It's a move Ferrier has supported in Ontario as a way to recognize PSWs as professionals and make sure they have the needed training.

That could backfire in the midst of a labour crisis though, Estabrooks said, because some existing workers might choose to leave the profession if they need to be regulated.

"We have to be thoughtful about if we're going to go that route," she said. Even without regulation, more could be done to make the homes better places to work and make sure workers get the same level of education across the country.

Making sure workers have full-time, permanent work would also be an improvement, said Bea Bruske, president of the Canadian Labour Congress.

"For these workers working on long-term care, all too often we still see that it's precarious work, that it's part time work," Bruske said.

Precarious work proved dangerous for residents during the pandemic, as employees travelled from home to home in an effort to work more hours, potentially spreading COVID-19 between residences.

If governments hold long-term care homes to the newly released standards it would be an improvement, Bruske said, but it will also come at a cost.

"Making sure that care homes have the resources to actually provide and to live up to that standard is an important piece," she said.

"And that can't come from individual residents having to pay giant fees, because that's not affordable."

This report by The Canadian Press was first published Feb. 1, 2023.

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